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HomeMy WebLinkAboutMiscellaneous - 18 DARTMOUTH STREET 4/30/2018UN 4 N �V Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ........... ` ..�-! ..........'4 >✓c S'. P- ....................................... ................ has permission to perform .. .................. I ...... ....................... plumbs in the buildings of ...P �`!...-!�4_._................................................ at .......... �..9,.e...... 7.` ........... North Andover, Mass. z�-2.0." 7` . . P BING INSPECTOR Check # 4z NOR7N Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ........... ` ..�-! ..........'4 >✓c S'. P- ....................................... ................ has permission to perform .. .................. I ...... ....................... plumbs in the buildings of ...P �`!...-!�4_._................................................ at .......... �..9,.e...... 7.` ........... North Andover, Mass. z�-2.0." 7` . . P BING INSPECTOR Check # 4z Date ..... j..0 -�.L� Lf ........ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Thiscertifies that U. ......................... 0,............a . ................................................... �4 has permission to perform ... . .. ....... . ..... ........ .............. ...... .... plumbing in the buildings of ....... (Ze.. t.l L . ................................................ at �.i ..... -DOL1.40. 117th Ldover, Mass. Fee4.L!.!? Lic. No. ..... PL ING INS C Check # r�- — (—U— MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT #- )Mn JOBSITE ADDRESSF It OWNERSNAME IV P OWNER ADDRESS :J TEL rjl-?,ej FAXI -S TYPE OR OCCUPANCY TYPE COMMERCIAL F-1 EDUCATIONAL 0 RESIDENTIALO PRINT CLEARLY NEW. 0 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES n NoF-1 I I FIXTURES I FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I L�j --: .-.- - --.-I I I -- ---- CROSS CONNECTION DEV 7 ICE 1-j DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OlUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK . ........ J... X ... ..... TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES r WATER PIPING OTHER 1. — -- - ------- ....... INSURANCE COVERAGE: I have a current liability insurancX111cy or Its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [] OTHER TYPE OF INDEMNITY [] BOND [j OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts Go L s,a tb" signature this permit application waives this requirement. 4 CHECK ONE ONLY: OWNER AGENTE- j rdN--A—TL& OF 0WN5-RDR AGENT I hereby certify that all of#9 details and Infoilrnallon I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing w* and Installations performed under the permit issued for this application YAI be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r PLUMBER'S NAME LICENSE# SIGNATURE MPO ip Z11 CORPORATION 0#=PARTNERSHIPU-- #= LLC [3 COMPANY NAME he .. , ADDRESS J_ 3-(f CITY STATETEL j ZIP FAX L CELL ' EMAIL A .. U I The Commonwealth of Massachusetts Department of IndustrialAccidents " I Congress Street, Suite 100 Boston, 3M 02114-2017 sy��•�t www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information F Please Print Legibly Name (Business/Organization/Individual): i] U S 1 ill„ Address: / Se c_cna r_-, S 4" City/State/Zip: (�-^I e3 �✓'�- . /11 f-1 D 1 � Are you an employer? Check the appropriate box: #: c79 `{Z, ?31S 1. ❑ I am a employer with employees (full and/or part-time).* 2.0 lam a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.# 6. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no. employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ® Remodeling 9. ❑ Demolition 10 Building addition 11.0 Electrical repairs or additions 12.0 Plumbing repairs or additions 13.0 Roof repairs 14. Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workeis' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lie. #: Expiration Date: -. Job Site Address: 19 Oar i K UO' 'Ft Sa- City/State/Zip: Aav-e M u - Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): ; 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi• confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation'policy, please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Date ......�.U.�. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... „( 6�c ; ,, l� .............................................................. has permission to perform .. !..7. r.�. .........moi? ......��`t ./.......................... � wiring m the building of..........�1'.t . ...........��.,/�.. J..�:..,��..._....................................... � at........ ..... / 6Id �%f , Nor" ndover, Mass. Fee..... /J.,...,........ Lic. No .................. ............ �. jg ®aD LECTRIC INSPECTOR Check # (� 14 Commonwealth of Massachusetts OfIm Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) / 8: Oyq cz�i h iQ`5S f Owner or Tenant L(/-1t1&X-If (-�IVA/I C, K Telephone No.7 7 1 r g3s, v 06 Owner's Address %-12 A;977 ov7--,k- -T t-� Is this permit in conjunction with a building permit? Yes Pq Purpose of Building leer d L Existing Service �,©� Amps New Service Amps No ❑ (Check Appropriate Box) Utility Authorization No. Volts Overhead ®, Undgrd ❑ No. of Meters_ Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cmmnlatinn nftho fnllnwina tnhlo mm) ho —i—d by tho 1— i— -,('W;— No. ,fw0..., No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. gryd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat PumpNumber. Totals: Tons "' KW "' "..'.......... No. of Self -Contained Detection/Alertine Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security No. ystems:f Devices or Equivalent No. of Water KW Heaters No. of No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommunications Wirmg: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 9- 607— Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE N BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete: FIRM NAME: LIC. NO.: Licensee: R a� � nature Si "a� �%a' .� d!7 f� r g L:�'_!� .�''�_ LIC. NO.:�"' (If applicable, enter " exem t" in the license number line.) Bus. Tel. No.: /4 V Address: old //- 1,04 1 it C- Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. [PERMIT FEE: $ BEAMA-1 OP ID: MS i4� Row CERTIFICATE OF LIABILITY INSURANCE DATE(M1ororzo1120 5 ls THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 978-388-2354 Gould insurance Agency, Inc.Fax: 978-388-5578 7 Market Square Amesbury, MA 01913-2494 CONTACT NAME: Matt Sherrill PHONE g7g-388.2354 AX No):978-388-5578 A No Ext ADDRESS: matts@gouldinsurance.com INSURER(S) AFFORDING COVERAGE NAIC p INSURER A : Merchants Insurance Group INSURED Arthur Beam 20 Hillside Ave Merrimac, MA 01860 INSURER B INSURER C : INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LTR TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover POLICY NUMBER MMI DY EFF POLI N DCDI EXP LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR X Business Owners N. Andover, MA 01845 BOP9097987 09/23/2015 09/23/2016 EACH OCCURRENCE $ 500,00 PREMISES Ea occurrence) $ 500,00 MED EXP (Any one person) $ 15,00 PERSONAL & ADV INJURY $ 500,00 GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 1,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PeOacEciRdenDAMAGE $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- I OTH- ITORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Electrical wiring CERTIFICATE HOLDER CANCELLATInN NORTHAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIVE N. Andover, MA 01845 ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1( .4czl .w LL Q w ! Q r pq y � rf Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 20,053.00 m $ - $ 240.64 Plumbing Fee $ 30.08 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.08 Total fees collected $ 400.80 18 Dartmouth Street 412-16 on 10/1/15 Kitchen Renovation lL 0 WTT V/ ^^(U CL c a L a+ o Sm J C CD O Ert6 W O 45 m O DOQ I C U C t O C Q C 41 Z O 1 n E O U O D G 0 m Z COMPLAINT NUMBER DATE: COMPLAINTANT : ��� U CLOSE DATE: ADDRESS: j v PHONE: OWNER: -7-7j5;r/� PHONE #: �= ADDRESS: INSPECTION DATE: ORDER L DATE: COMPLAINT: ACTION: f/UJT 1511Ay 7-0 7) Pzj TO DA Tim - FROM ARF,4 V7;f NQ! IBEP OF uj cn U) w :Z--. I ML MEM "V—ALL" n BACK "hLL C LL F] Z. a4t-'IS tO WA5 t. -C im AMPAD NO. 23-176-400 SETS NO. 23-376-200 SETS /• 'R COMPLAINT NUMBER DATE: #81 NOVEMBER 3, 1993 COMPLAINTANT:DENISE STEWART CLOSE DATE: ADDRESS:25 ENFIELD STREET PHONE: 686-7836 OWNER:UNKNOWN PHONE #: ADDRESS:18 DARTMOUTH STREET INSPECTION DATE: ORDER L DATE: COMPLAINT:STRONG SMELL OF SEWAGE. MRS. STEWART SAID IF YOU GO OUT IN HER YARD, YOU CAN SMELL THE SEWAGE AND SHE THINKS IT IS COMING FROM 18 DARTMOUTH STREET. ACTION: /�� 0, IZ 3D 56zd6;�e �JT3- FROM 1 Li OF � W �� NED ' AETURNCD "jj� C'ALL � V'OILL CALL �l � CALL 1 BACK I ApAG4_ AM PAD NO. 23-176-400 SETS NO. 23-376-200 SETS b COMPLAINT NUMBER DATE: #87 NOVEMBER 26, 1993 COMPLAINTANT:MRS. MOODY CLOSE DATE: ADDRESS: PHONE: OWNER:RICHARD BOVE PHONE #: 683-3821 ADDRESS:18 DARTMOUTH STREET INSPECTION DATE: ORDER L DATE: COMPLAINT:SEPTIC SYSTEM OVERFLOWING. SMELLS OFFAL. ACTION:11/26/93- 9:00 A.M. - I (CAROL) CALLED MR. BOVE AND MENTIONED THE COMPLAINTS AND RECOMMENDED THAT HIS SEPTIC SYSTEM BE PUMPED AGAIN. THF LAST RECEIPT FOR PUMPING IS DATED 11/10/93. HE DIDN'T SEEM TO BELIEVE THAT HIS NEIGHBORS WERE SMELLING HIS SYSTEM BECAUSE HE DID NOT SMELL ANYTHING YESTERDAY. MRS. MOODY SAID THE SMELL WAS SO BAD THAT THE CHILDREN COULD NOT GO OUT AND PLAY. AMPAD NO. 23-176-400 SETS NO. 23-376-200 SETS I Af AMPAD NO. 23-176-400 SETS NO. 23-376-200 SETS COMPLAINT NUMBER DATE: #88 NOVEMBER 26, 1993 COMPLAINTANT:DENISE STEWART CLOSE DATE: ADDRESS:25 ENFIELD STREET PHONE: OWNER: RICHARD BOVE PHONE #: (a $ 3 3 S 2-1 ADDRESS:18 DARTMOUTH STREET INSPECTION DATE: ORDER L DATE: COMPLAINT:THE SEPTIC SYSTEM YESTERDAY (THANKSGIVING DAY) WAS DISGUSTING. THE SMELL WAS INTOLERABLE. ACTION:11/26/93 - 9:00 A.M. - I (CAROL) CALLED MR. BOVE AND MENTIONED THE TWO COMPLAINTS AND RECOMMENDED THAT HIS SEPTIC SYSTEM BE PUMPED AGAIN. THF LAST RECEIPT FOR PUMPING IS DATED 11/10/93. HE DIDN'T SEEM TO BELIEVE THAT HIS NEIGHBORS WERE SMELLING HIS SYSTEM BECAUSE HE DID NOT SMELL ANYTHING YESTERDAY. TG` 4 1 DATE TI FROM - A ?E CC OE NwWBEEH a �r OF OXIS uj I >fi i cn to �1 W — - - — GNED � 11 it (mayp JGE M f CALL I sect. ❑ !4A� ?* ❑ 4 •� L Y *o I x, t r I $iL flYitlf4L� 044 V'UC y PHw 7 a1 � 1 c. �O, —) AMPAD NO. 23-176-400 SETS NO. 23-376-200 SETS INVOICE Bateson Enterprises Inc. lormerty Ray Fortuna 111 Argilla Road • Andover, Mass. 01810 sold 10 c . Tel. (617) 475-1474 t� a6.19� Received by AMOUNT DUE Received by SENDER: °f • Complete items 1 and/or 2 for additional services. I also wish to receive the w • Complete items 3, and 4a & b. following services (for an extra m my • Print your name and address on the reverse of this form so that we can V m return this card to you. fee): m • Attach this form to the front of the mailpiece, or on the back if space 1. ❑ Addressee's Address N does not permit. r m -Write "Return Receipt Requested" on the mailpiece below the article number. O t 2. ❑ Restricted Delivery W • The Return Receipt will show to whom the article was delivered and the date C delivered. Consult postmaster for fee. m 3. Article Addressed to: m Rich;�..rd Bove 0 18 Dartmouth Street CA North .Andover, j,IA 01845 caW fS O D Q =I 5. Signature (Addressee) H 6. Airature (Agent) 0 PS Form 3811, Decem 4a. Article Number c P 273 797 665 4b. Service Type d ❑ Registered ❑ Insured o� Certified ❑ COD 6 ❑ Express Mail ❑ Return Receipt for w= Merchandise 7. Date of Delivery w 0 8. Addressee's Address (Only if requested Y and fee is paid) c 0 t I- 1991 * U.S.G.P.O.:1992-307-530 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE, $300 Print your name, address and ZIP Code here � \iFft Rt}ARD �F �f�1.Y� 120 Q L P 273 797 665 Receipt for Certified Mail No Insurance Coverage Provided TED STATES Do not use for International Mail POSTAL SERVICE (See Reverse) Sent to Richard Bove Street a d No. l� Dartmouth St. P.O., State and ZIP C de No. Andover, MA 0184 Postage $ 2.29 Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees $ 2.29 Postmark or Date sent 11/8/93 0 Of ,&ORTN 'A4" a 0 F"Z) BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 Richard Bove 18 Dartmouth Street North Andover, MA 01845 Dear Mr. Bove: November 8, 1993 TEL. 682-6483 Ext23 Certified #P 273 797 665 On November 8, 1993, in response to a complaint an inspection was made by authorized Board of Health personnel of 18 Dartmouth Street. This inspection revealed that effluent from your septic system was discharging to the ground surface, signifying that your leaching area has failed. This is a violation of 310 CMR 15.02(19) and (20) of the State Environmental Code, Title 5: Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and local regulations. You are hereby ORDERED to: 1) Pump your septic system immediately and continue pumping on a regular basis to prevent sewage from reaching your failed leaching area. Copies of pumping reports are to be sent to the Board of Health. 2) Secure the services of an engineer to determine the best solution for the remediation of the problem. The septic system must either be repaired or you must tie-in to the municipal sewer. 3) Notify the Board of Health concerning your plan of action. You are entitled to a hearing before the Board of Health to determine if this Order should be modified or withdrawn. All requests for hearings must be in writing and must be submitted to this office within seven (7) days after receipt of this order. Please note that "Any person who shall fail to comply with any Order issued pursuant to the provisions of this Title shall, upon conviction, be fined not less than 10 nor more than 500 dollars. Each day's failure to comply with an Order shall constitute a separate violation." I 0 fN . , 4k If you have any questions, please do not hesitate to call the office. Sincerely, Sandra Starr Health Sanitarian/Agent cc: Karen Nelson, Director PCD File INVOICE Bateson Enterprises Inc, Ray Fortuna Tei. (617) 475-1474 111 Argilla Road Andover, Mass, 01810 Sold to�, Q l J�Ue S � l► �o- SIZE 500 DESCRIPTION 1000 UNIT TOTAL 1500 , 2000 2500 Received by _ AMOUNT DUE v-tt��o ,�.•ry t BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 November 17, 1993 Mr. Richard Bove 18 Dartmouth Street North Andover, MA 01845 Dear Mr. Bove: I understand that you have decided to tie-in to the municipal sewer system as a remedy for your failed septic system. Please notify the Board of Health when the tie-in has been completed. Thank you. SS/cj p Sincerely, Sandra Starr Health Agent �' t pORTF� O ,,.,to,eg10 A Y 1. t SSACHUSE 0 BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 April 5, 1990 Mr. Richard Bove 18 Dartsmouth St. No. Andover, MA 01845 Dear Mr. Bove: TEL: 682-6483 Ext. 32 or 33 At a site visit on your property on April 5, 1990, it was discovered that your septic system has failed. Effluent is surfacing through the soil from your leach area and there is a distinct odor of septage in your backyard. You are being requested to correct the problem on or before April 11, 1990 or you must appear before the Board of Health on April 11th at 7:30 PM in the Health Office at Town Hall. After speaking with the Department of Public Works, I have been assured that it is possible to tie into sewer. You will have to hire an engineer to determine the possible route of the access to the sewer system. If you have any questions, please contact me at 682-6483 Extension 32. SF/rel Sincerely, Stephanie J. L. Fol Health Sanatarian Mr. Richard Bove 18 Dartsmouth St. N. Andover, MA. 01845 April 5, 1990 Mr. Bove: At a site visit on your property on April 5, 1990, it was discovered that your septic system as failed. Effluent is surfacing through the soil from your leach area and there is a distinct odor of septic in your backyard. You are being requested to correct the problem on or before April 11, 1990 or you must appear before the Board of Health at 7:30 in the Health Office at Town Hall. After speaking with the Dept. of Public Works, I have been assured that it is possible to tie in to sewer. And Engineer will have to be hired to determine the possible route of the access. If you have any questions, Please contact me at 682-6483. Sincerely, Stephanie J. L. Foley Health Sanitarian Richard Redmond 1 y Paul Riess APPLICATION FOR SEWAGE DISPOSAL IRSTAUATION Darthmouth St. HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Dartfunouth St. . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1000 gals in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 200 lineal (KXX ) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. -I DATE J12/ •,�3 d ::2- Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DA TE�ir ignature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE It �G Signature of qOpecting Officer Percolation Test 6 mi,:. Soil: Sandy -clay Garbage Grinder No 4 i +� BOARD OF HEALTH TOWN OF NORTH ANDOVER MASS. .,1 10'-4 3 z' 3 3Zl . Ilii o� 1 co -o G��. �a�c. ��va1< 4f 3ol I 24- � 7-0 I. NAIt� '. ' 1 C. k1 A f?J 1� e c� m C � d 4 in�1 " �.. .� � DATE 2. ADDRESS I ; �;:�'; '�� . :. �. �' : j. LOT N0, , s . , TEL. q. V:q. `. �,� Z_,.• 3. NO, OF BEDROOMS . 0'a DEN YES NO. Q. GARBAGE GRINDER YES , . NO, r. . 5. SHOW DIDENSIOIV.S OF HOUSE '.� e/ X J- 0 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMNSIONS OF LOT g, SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AIJD DISTANCE OF WELL FROM SEWERAGE SYSTEM 10, SHOW LOCATION OF BROOKS, STREANSp DITCHES., LEDGE OUTCROP, ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY, h J F N 0 J W Iowa LL Z al m N \NtLLIAM R V,%JAA BA t-.. L. N ET. AL1. F aANv, P : MAaY M . �51LF N 100.0 f 1 a A zeb, = IS boo sq, F .... 100.0 .. ... � J I� 0 0 0 U OAWIEL MARY C 2A L Cr 4 tL r� 4o 2GS ?GS /.P SALEM TURNPIKE 'o PLAN OF Lois ►N NofzTw QMAGG'm Tc gE- To PAUL a. 12 1Ess SCL-.LE• t=.d.o' New. tgG2 �102Tt 1 QNOOVEtt � �FaSS . � . W �Qf�,S5EtJ2 l�SSoCtLSTES GD%z, �At t_Ey ST. CoMT�II.Ep FRonn EXlS-rkt4G fzocotzon� t-tAv�tLHtt_t_ Ass. �i O � ' r —ne a N � J J � _ N ci z o 0 l� f z Z W J 27v • • .� SO.O � 20.45 SALEM TURNPIKE 'o PLAN OF Lois ►N NofzTw QMAGG'm Tc gE- To PAUL a. 12 1Ess SCL-.LE• t=.d.o' New. tgG2 �102Tt 1 QNOOVEtt � �FaSS . � . W �Qf�,S5EtJ2 l�SSoCtLSTES GD%z, �At t_Ey ST. CoMT�II.Ep FRonn EXlS-rkt4G fzocotzon� t-tAv�tLHtt_t_ Ass. f11?_r.' x_? _% 1990 -Mr_. Egoy-C?, ..._---!gin_ _ Y_ t 4.p°..__._�"_ �"fi t k_ FYI—_f Ar^ ]_— _, 1 0,._..__x t__, w�-xV. I.Ii�YIt___1_:i fr^k:lm _your 1LLjch w?r^e�q ar�d_• there is i n c t _ odor p.r:,��• E'1,.._y.a;Ln Ltr _ backyard. tr^c;._.._bc xt E:tit_nd tc�...c�-�r�rE�.c�L__thc�..._..pr�c�bIgm.wor!.__or•� befc�r,C~.__�1pr^_i.l thC,._lti�}t_d__�7f__Fi�tlth 7:30 i n __t hr, Fli a_l t h O f f i,ce _-it Town Hall. i.ng_wipr'1?t�_..._..._4;!f__ tt�<�t it._..._�`.''_F7�at>�sx_l�_Xc�-tat; xc�__i�itp s�1L16pr. Y" --w 11_h � E� �;�-� _ _._ _.. __f11r .„oto C?rlg.i,_i' ps?r^_. b_C! dotormiric? t�lC'. �' >x iI� r Y” i�ttc� � i' t:_k1C.. up--PRfl i L tti xi:; _inr—c,��wrr"_r.ys,t.c M. ---- ___- ;*„_F� C'cA.Sit?._ CC, It!%C C'CTi"t'r�Y L . ,. £= ny_. a rl._.._